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www.england.nhs.uk
Steve JonesNational Service Advisor
Children & Young People’s Mental Health Programme
Medical Directorate, NHS England
Children & Young People’s Emotional Wellbeing & Mental
Health
Burgess Hall, St IvesThurs 30th November 2017
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CYP Emotional Wellbeing & Mental Health – working with schools & colleges.
Overview1. Setting the scene - why it matters: Recap
2. Policy overview - what NHS England is doing
3. DfE schools link pilot - strategic cross-system work
4. Case studies – so many great examples
• PHSE
• Birkenhead 6th Form BePART programme
• Sheffield Healthy Minds framework
• Y&H Humber – Schools CYPMH competency framework
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Children & Young People’s Mental Health
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Figure cited in: Measuring Mental Wellbeing in Children and Young People (PHE, 2015)
Prevalence estimates are based on ONS 2004 Survey of Mental Health of Children and Young People in Great Britain.
Estimates applied to 2014 mid year population children aged 5 – 16 years
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Mental health problems are the greatest health
problem faced by children and young people
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Why it matters - children and young people’s mental health and wellbeing
Mental health as physical health includes a diverse range of problems requiring a full range of services and interventions;
The death rate for people with severe, prolonged mental illness is 4 times higher than for others;
people with psychoses will die at least 15–20yrs earlier
20% of people with anorexia will die prematurely.
Children & young people may also need help when they experience adverse life experiences – bereavement & loss, abuse & exploitation, enduring distress & trauma;
CYP mental health difficulties may not have developed to be identified as a discrete psychiatric diagnostic category
Some vulnerable groups of CYP have both higher rates of MH disorder and impaired access to services, (LAC, CLD, H&J etc)
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Youth Mental Health:
New Economic Evidence
Mental health related costs for 12-15 yr olds average £1778 pa over only
3yr follow up. (NB health, social care and school-based costs only - did not include employment, welfare benefits or criminal justice)
Highest costs for hyperkinetic disorders (£2,780 pa)
Education system incurred 90% of assessed costs (£1,564 pa)
Youth justice system: YP 8x more likely to have contact (with additional
costs) over 18 month.
Benefits: twice as likely to be claiming benefits (27% vs 14%)
Treatment gap: less than half (45%) of 12-15/16-25yr olds were in contact
with services related to their MH needs, 54% if severe mental illness. Treatment gap has been known about for two decades.
Lower rates of service contact than any other age group
Martin Knapp et al, 2016
PSSRU, LSE 7
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• Children with Conduct Disorder are 10 times more costly to the
public sector by the age of 28 than any other child
• Overall lifetime costs associated with moderate behavioural
problem amount to £85,000 per child
• Severe behavioural problem: £260,000 per child
Economic case for change: FiM examples
An example of cost-effective intervention from NICEAdditional cost-effectiveness for lifetime earning gains not included
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NHS England: Five Year Forward View for Mental Health into actionClear, consistent policy direction for mental health and for the first time, an implementation plan (July 2016) sets out national objectives, expected trajectories and funding available for all priority areas within the FYFV-MH.
CYP MH transformation supported by £1.4bn additional funding announced during 2014/15:
£30m per year for eating disorders £1.25bn over 2015-2020 for wider transformation (including £15m per
year for perinatal mental health)
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NHS England: 2020 commitment
At least 70,000 more CYP receiving swift and appropriate access to care each year
Completed national roll-out of CYP IAPT programme with at least 3,400 more staff in existing services trained to improve access to evidence based treatments
1,700 additional new staff to support improved access to evidence based treatments
Evidence based community eating disorder services for CYP across the country95% of those in need of eating disorder services seen within 1 week for urgent cases & 4 weeks for routine cases.
Improved access to and use of inpatient care, having the right number and geographical distribution of beds to match local demand with capacity, and leading to an overall reduction in bed usage.
Improved crisis care for all ages, including investing in places of safety
By 2020, there will be system-wide transformation of the local offer to children and young people underway, with Local Transformation Plans (LTPs) embedding Future in Mind principles and fully integrated into Sustainability & Transformation Plans (STPs):
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National CYP MHS initiatives
Local Transformation Plans: whole system plans refreshed yearly with the inclusion of schools & colleges.
Commissioner Development Programme: Regional seminars “building robust partnerships – education spotlight
Children & Young People’s Improving Access to Psychological Therapies (CYP-IAPT). Evidence-based interventions training including CYPF participation and self referral. (Note EEBTP module).
Children’s Wellbeing Practitioners: (CWPs) providing low intensity support in primary care, and schools & colleges
Community Eating Disorders teams
Urgent & Emergency CYP MH Care - Crisis services
CYP MH Services and Schools Link Pilot: testing models of joint training and points of contact within schools and CYP MH services. Wave 2 – Autumn 2017
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CYP Eating Disorders Services
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Standard: 95% of those needing an eating disorder service start treatment within 1 wk for urgent cases & 4 weeks for non-urgent/routine cases.
How are we doing it?• Access and waiting time standard introduced in 2016/17 and monitored via MHSDS and UNIFY data
collection. The eating disorder pathway is being extended to include episodes of care in day and inpatient settings with the involvement and oversight of the community eating disorder team
• Multi-disciplinary community eating disorder teams are being set up across the country
Education & Training• Systemic family practice curriculum for eating disorder• Whole team training available for multi-disciplinary community eating disorder services/teams – being
delivered 2017• Modality specific evidence based interventions to be in line with updated eating disorder NICE guideline
published in May 2017 – curriculum for CBT–ED in CYP IAPT
Results (Q2 of 2017-18) 71% urgent cases seen with 1 wk (n=203/286 ) 82% non-urgent cases seen within 4 wks (n= 1099/1333) Substantial 45% rise in CYP entering treatment (n= 1154 to 1619)
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Evidence Based Treatment Pathway for Urgent
& Emergency Mental Health Services for CYP
A mental health crisis is a situation which the child, young person, family
member, carer or any other person believes requires an immediate
response, assistance and/or care from a mental health service. This includes
where there is a significant risk of harm to themselves or others
Services should provide effective and timely 24/7 urgent and
emergency mental health care
Parity of esteem: CYP should receive an evidence-based package
of care within four hours of being referred.
Children & young people
experiencing a mental health
crisis and their families
should be able to access the
right care, in the right place, at
the right time.
“When I experience a mental
health crisis I will have access to
support from services no matter
where I am, what time of day it is
or which day of the week.”
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Testing Improvements for CYP UEC MH (Crisis) Care
Phase 1 Vanguard evaluation - August 2017
Two CYP MH Crisis & Liaison Models (Co Durham and Teesside): Prompt open access to dedicated, staffed team offering supportive, individualised
care with continuity of response
Response times:
o 60% of CYP referred were seen within 1 hour of referral being made
o over 75% seen within 4 hours.
CYP and family experience: very highly rated by CYP, families and stakeholders
Dedicated CYP crisis telephone support, advice and triage improved access, response times and provides flexible/individualised support
CYP crises effectively managed in community settings with less recourse to ambulance transport, A&E attendance and inpatient admission.
Substantial cost reductions identified, (esp to paediatric inpatients)
Rates of crisis presentations were similar and remained broadly stable over time.
CYP and families contributed to shaping a clear service vision.
CYP Mental Health Services and Schools Link Pilot
AIM: Strengthen links between CYP Mental HealthServices and Schools
NHS England and DfE funded pilot during 2015-16 Joint training programme between schools,
CYPMHS and other agencies, voluntary sector etc
Objectives: How training and subsequent joint working between schools & CYPMHS
can improve local knowledge and identification of mental health issues; Test the concept of a lead contact in schools and CYPMHS; Improve referrals to specialist (and other) services;
22 pilot sites across the country - 27 CCGs and 255 schools
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Schools’ Pilot Impact & Outcomes
Considerable success in achieving primary outcomes:
Strong, statistically significant improvements in:
o Knowledge and awareness of mental health issues
o Understanding and awareness of referral routes
o Confidence in supporting CYP with mental health issues
Corresponding improvements among wider staff in whole school survey
Improvements in frequency and quality of communication between schools and specialist community CYPMHS.
Improvements in quality and consistency of referrals, without a corresponding net increase in total referrals across the pilot.
Very promising early signs of changes to whole school policies, resources and staffing within pilot schools.
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Emerging models tested
A
CYP MH Service
named lead :
working in schools on
a regular basis,
delivering services and
support directly to
both staff and CYP.
B
CYP MH Service
named lead :
offering dedicated
training and support
time to school-based
professionals.
C
CYP MH Service
named lead / duty team
with single point of
access
No single model emerged as being most effective at this stage -approaches tailored to local needs, circumstances, resources etc.
Key considerations: CYP MH Service capacity; levels of demand from schools, scaling up and sustainability.
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PSHE and health behaviours
Association between young people’s health behaviours and their perception about the extent
to which health and wellbeing was covered well in PSHE classes
Health and
wellbeing covered
well
Health and
wellbeing covered
poorly
Self-harmed 19.2% 30.3%
Smoked on 6 or more days in last
30 days
6.1% 8.4%
Drunk alcohol 6 or more times in
last 30 days
5.5% 9.0%
Drunkenness 4 or more times in last
30 days
1.1% 3.0%
On a diet 17.5% 22%
Eat breakfast every day 59.7% 52.5%
Link between health & wellbeing and attainment18
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BePART Life Skills Developed by expert
psychologists
applying evidence based
practices
assist both academic and
emotional well-being
(Did not include on-site
counselling / therapy.)
Six week programme: Challenging negative thoughts
Sleep & diet
Building resilience etc
Evaluation
Liverpool John Moores Univ.
Early findings: significant
success in assisting student
wellbeing
Birkenhead 6th Form College
Schools & college staff care passionately about their students’ wellbeing and
need better guidance and support from us in their commitment.
6,000 Specialist community CYPMHS practitioners in England
700,000 FTE teachers and teaching assistants (plus colleges etc)
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Framework purpose Improve schools capacity to
contain EW & MH issues in school where possible, and
Ensure CYP who need CAMHS receive a better service.
Holistic model requires school to work through the three levels.
Three levels Bronze (universal): whole
school training and identifying EWBMH needs in the school.
Silver (targeted): supporting pastoral teams and meeting the needs of the school that have been identified at the bronze level
Gold (vulnerable): provides direct CAMHS input alongside other services into the school for specific vulnerable children.
Sheffield Healthy Minds Framework
What students said Improve school culture (38%)
Improve communication &
listening skills (33%)
Staff more pro-active (25%)
(School counsellor <5%)
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A framework of workforce competencies for education settings to enable staff to appropriately care for and support children and young people’s mental health and emotional wellbeing in line with the workforce ambitions of Future in Mind.
Y&H CYP MH Clinical Network
Schools Competency Framework
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Principles Evidence based – defined, achievable outcomes
Address diverse needs of CYP
Prevent use of ineffective interventions
Make best use of the workforce
Clearly define roles and responsibilities where CYP
EW&MH is everybody’s business
Promote staff wellbeing
School Competency Framework
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Three tiers of competencies
Core, enhanced & targeted tiers
Not just knowledge of CYP mental health
Self-assessment tool
Evidence based training/resources directory
Framework’s Components
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Schools Competency Framework
Staff Group Example - Secondary School
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Further opportunities – Children & Young People’s Mental Health Green Paper
Announced by the Prime Minister on 9th January 2017 as part of a suite of commitments to improve and transform CYP mental health
The Green Paper is being developed between Department of Health and Department for Education with close involvement from NHS England and Public Health England.
Recognises the importance of different settings, not just the NHS.
CYP MH Services and Schools Link Pilot is informing the development of the Green Paper: it is expected that schools and colleges will be a key focus
as well as addressing better access to NHS services and role of digital & social media in maintaining wellbeing
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Resources
• Resource for all adults to increase awareness and understanding
• Includes free e-learning sessions for all those working with CYP (incl. ED sessions)
• MindEd for Families
https://www.minded.org.uk/
GIFT Sign up for www.myapt.org.uk;
see video clips
https://www.youtube.com/user/Cern
isLimited/videos
http://positivepracticemhdirectory.org/
For CED-CYP
Case studies
www.NHSGo.uk
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My Mental Health Services Passportwww.england.nhs.uk/mentalhealth/2015/10/15/passport-brief-yp-
mh
Developed by young people and
parents/carers with NHS England as part of
the CYP IAPT programme
The aim of the passport is to help young
people using services to own and
communicate their story when moving
between different services.
The passport provides a summary of young
person’s time in a service, for the
information will be owned by the young
person, and for it to be shared with any
future services if the young person wishes
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• New online resource created for and
with parents and carers to help improve
mental health care for children and young
people
• Over 900 parents/carers identified 5 key areas:
• access, equality and diversity
• communication
• service leadership and delivery
• methods of engagement
• workforce development
• Best practice case studies,
videos, resource directory
www.youngminds.org.uk
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Tools to help schools understand
CYP MH & WB needs and how
best to plan to respond?Contact:
Claire Robson
Public Health England
www.england.nhs.uk
www.england.nhs.uk 33Measuring & monitoring children and young peole's mental wellbeing: a toolkit for schools and colleges
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Support from PHE – useful linksPromoting children and young people’s emotional health and wellbeing: a whole school approach
https://www.gov.uk/government/publications/promoting-children-and-young-peoples-emotional-health-and-wellbeing
For: head teachers, college principals, school and college governing bodies and staff working in education settings,
school nurses, local public health teams, academy chains, others with a role of promoting health and wellbeing of children
and learners
Aim: to describe 8 principles, informed by evidence and practice, for promoting emotional health and wellbeing in schools
and colleges
A public health approach to promoting young people’s resilience
http://www.youngpeopleshealth.org.uk/wp-content/uploads/2016/03/resilience-resource-15-march-version.pdf
For: policy makers, commissioners, service planners and providers
Aim: Funded by PHE, and developed by the Association for Young People’s Health with input from the Early Intervention
Foundation. Provides a new focus on public health approaches to supporting young people’s resilience. It highlights ways
that services have successfully worked together, provides links to useful interventions and other resources, and draws on
the perspectives of young people about what works well for them. The resource is an interactive PDF with embedded
hyperlinks
A public health approach to promoting young people’s resilience
http://www.youngpeopleshealth.org.uk/wp-content/uploads/2016/03/resilience-resource-15-march-version.pdf
For: policy makers, commissioners, service planners and providers
Aim: Funded by PHE, and developed by the Association for Young People’s Health with input from the Early Intervention
Foundation. Provides a new focus on public health approaches to supporting young people’s resilience. It highlights ways
that services have successfully worked together, provides links to useful interventions and other resources, and draws on
the perspectives of young people about what works well for them. The resource is an interactive PDF with embedded
hyperlinks
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Support from PHE – useful links
Children & Young People’s mental health and wellbeing profiling tool
http://fingertips.phe.org.uk/profile-group/mental-health/profile/cypmh
Collects together in one place metrics from many sources covering risk, prevalence, health, social
care and education to support commissioners and service planners across the pathway
Suicide prevention: developing a local action plan
https://www.gov.uk/government/publications/suicide-prevention-developing-a-local-action-
plan
Promoting positive wellbeing and emotional health of children and young people
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/299268/Emotional_H
ealth_and_Wellbieng_pathway_Interactive_FINAL.pdf
This pathway contains evidence based information on guidance for professionals form the school
nursing and Child and Adolescent Mental Health Services/ mental health practitioners and promotes
improved partnership working and enhanced early support
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PHE Tools and Resources • Promoting children and young people’s emotional health and wellbeing: a whole school approach -
https://www.gov.uk/government/publications/promoting-children-and-young-peoples-emotional-health-and-wellbeing
• A public health approach to promoting young people’s resilience - http://www.youngpeopleshealth.org.uk/wp-
content/uploads /2016/03/ resilience-resource-15-march-version.pdf
• Measuring and monitoring children and young people's mental wellbeing: a toolkit for schools and colleges -
http://www.annafreud.org/services-schools/mental-health-in-schools/schools-in-mind/resources-for-schools/mental-
health-toolkit-for-schools/
• ChiMat Mental Health and Psychological Wellbeing service planning tools - http://www.chimat.org.uk/camhs
• Children & Young People’s mental health and wellbeing profiling tool - http://fingertips.phe.org.uk/profile-
group/mental-health/profile/cypmh
• Measuring mental wellbeing in children and young people (published October 2015) - Measuring Mental
Wellbeing in Children and Young People
• Mental health in pregnancy, the postnatal period and babies and toddlers: needs assessment report
(December 2015)
• Comprehensive CAMHS integrated workforce planning tool- http://www.chimat.org.uk/camhstool
• Promoting positive wellbeing and emotional health of children and young people -
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/299268/Emotional_Health_and_Wellbei
ng_pathway_Interactive_FINAL.pdf
• Minded - https://www.minded.org.uk/
• National reading scheme to support young people’s mental health -
https://readingagency.org.uk/news/media/new-national-reading-scheme-to-support-young-peoples-mental-health.html
• JSNA support pack, Key data for planning effective young people's substance misuse interventions in 2016-17
- http://www.nta.nhs.uk/uploads/jsnadatapackyoungpeople2016-17.pdf
